氟比洛芬酯联合“鸡尾酒”疗法在老年全膝关节置换术的应用

Application of flurbiprofen axetil combined with “cocktail analgesia” in elderly patients undergoing total knee arthroplasty

目的探讨氟比洛芬酯联合"鸡尾酒"镇痛用于全膝关节置换术(TKA)老年患者的镇痛效果及对术后睡眠质量的影响。方法择期行单侧TKA老年患者80例随机均分为两组。两组均实施"鸡尾酒"镇痛:术中假体安装完成后关节腔及囊内注射罗哌卡因150 mg+吗啡5 mg+肾上腺素0.3 mg+氨甲环酸1 g;术毕行静脉患者自控镇痛。FA组于切皮前15 min缓慢静脉注射氟比洛芬酯2 mg/kg,C组静脉注射等量脂肪乳。分别于术前1 d(T0)、术后6 h(T1)、24 h(T2)、48 h(T3)及72 h(T4)时记录患者静息及运动后VAS疼痛评分;分别于T0、T2及T4时记录患者匹兹堡睡眠质量指数量表(PSQI)及失眠严重指数量表(ISI)评分。记录术中雷米芬太尼用量、首次补救镇痛时间及术后补救镇痛次数。记录术后肠蠕动恢复时间、住院时间及术后72 h内不良反应发生情况。结果与C组相比,FA组术中雷米芬太尼用量及术后补救镇痛次数减少,首次补救镇痛时间延长(P<0.05),T1~T4时静息及运动后VAS疼痛评分以及T2和T4时PSQI和ISI评分降低(P<0.05),肠蠕动恢复时间和住院时间缩短(P<0.05)。两组术后不良反应发生率差异无统计学意义(P>0.05)。结论氟比洛芬酯联合"鸡尾酒"镇痛用于TKA老年患者术后镇痛效果更好,可有效减少阿片类药物用量,改善睡眠质量。

Objective To explore the effect of flurbiprofen axetil combined with "cocktail analgesia" on pain and sleep quality in elderly patients undergoing total knee arthroplasty(TKA).Methods Eighty elderly patients undergoing unilateral TKA were randomly divided into two groups with 40 cases each.The "cocktail analgesia" was performed in both groups,which included the articular cavity and articular capsule injections of ropivacaine 150 mg+morphine 5 mg+adrenaline 0.3 mg+tranexamic acid 1 g after the prosthesis was installed.Patient-controlled analgesia was performed after operation in both groups.Flurbiprofen axetil 2 mg/kg was intravenously injected in 15 minutes before skin incision in group FA and the same volume of fat emulsion instead of flurbiprofen axetil was injected in group C.The VAS pain scores at rest and after movement were recorded one day before operation(T0) and at 6 hours(T1),24 hours(T2),48 hours(T3),and 72 hours(T4) after operation,respectively.The scores of Pittsburgh Sleep Quality Index(PSQI) and Insomnia Severity Index(ISI) were recorded at T0,T2 and T4,respectively.The consumption of remifentanil,the first supplementary analgesia time and the times of postoperative supplementary analgesia were recorded.The recovery time of intestinal peristalsis,hospital stay and adverse responses within 72 hours after operation were recorded as well.Results Compared with group C,the consumption of remifentanil and the times of postoperative supplementary analgesia were decreased,the first time of supplementary analgesia was prolonged,the VAS pain scores at rest and after movement at T1-T4 and the scores of PSQI and ISI at T2 and T4 were decreased,and the recovery time of intestinal peristalsis and hospital stay were shortened in group FA(P<0.05).There was no significant difference in the incidence of postoperative adverse responses between the two groups(P>0.05).Conclusion Flurbiprofen axetil combined with "cocktail analgesia" is more effective for postoperative analgesia in elderly TKA patients,which can effectively reduce the needs of opioids and improve the quality of sleep.